Entry Form

Sunday 16th October 2022 
Warm up 9.00 am– 9.25 am

Queen’s Diamond Jubilee Centre
Bruce Williams Way
Rugby
CV22 5LJ

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* 1. Athletes Name

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* 2. Athletes Swim England Number

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* 3. Athletes Club

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* 4. Athletes Classification

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* 5. Event Entries 
Please add your entry time in the relevant box, or add YES if you have no time (please note these seeded with no time in the earlier heats)

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* 6. Email Address
This will be used for contact by the organiser and for invoicing of entries, please note the invoice will come from East Midlands

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* 7. Please let know if any of the following applies
Please note the referee and duty lifeguards will be made aware as appropriate

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* 8. I acknowledge that I have read and understood the conditions of the meet, and I further acknowledge this will be a nut free event both on poolside and in the balcony/spectator area

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